Overactive and Underactive Let-Down
Breast milk let-down is a normal and necessary function in the process of lactation and breastfeeding. However, sometimes issues may arise that can cause concern for a new mother. One of these issues is an overactive, or underactive, let-down.
Overactive let-down is defined simply as milk that is flowing too fast.
The main reason for overactive let-down is a mother having an overabundant milk supply. Signs of an overabundant milk supply are frequently engorged breasts – despite feeding the baby as needed, leaking milk throughout the day, or the “spraying” of milk. Overactive let-down is most commonly experienced in the first two months of breastfeeding. It is also often an issue when the baby hits a growth spurt and is nursing more frequently, which in turns causes the breast to produce more milk.
When a mother is experiencing overactive let-down, her baby may have problems nursing. Some behaviors a nursing baby may exhibit when there is overactive let-down are: the baby may
- gasp and choke, due to milk entering the mouth too fast,
- pull away from the breast,
- refuse the breast,
- frequently spitting up,
- be very gassy, and
- gain weight very rapidly.
There are some things, however, that a mother with an overabundant milk supply can do to help make it easier for her baby to handle the milk flow and get the fattier part of the milk. The mother should find a posture that enables the baby's head to move freely to handle the flow of milk. (A suggested position is the mother in a reclining position with the baby's body supported on the mother's, enabling the baby to work with the milk flow, not against it.) Another suggestion is to try gentle compression on the breast that your baby is nursing on, so that some of the hind milk gets to the baby
On the opposite side of overactive let-down is, of course, underactive or slow let-down.
It is a main belief that some of the causes of underactive let-down and decreased milk production are stress, fatigue, and diet. However, that is not the case. Sometimes decreased milk production and slow let-down is influenced by placental fragments still left inside the uterus. Other causes include smoking, medication, breast surgery, and pregnancy after the third month. If your baby is frustrated during a feeding, showing signs of fussiness when offered the breast, or is slowly gaining weight, you may have underactive let-down.
A mother can do several things to encourage faster milk let-down. Have your partner massage you and/or lovingly talk to you while you are nursing. This helps release oxytocin, which is conducive to milk flow. You can also touch and sing to your baby to help produce oxytocin. Visualizations of waterfalls and milk flowing can help as well. If your milk supply does not increase after trying these things, consult a physician to check for any placental fragments or medication changes.
Milk let-down issues can be easily resolved; don't let your milk let-down let you down!